2.1 Ageing and the Body Flashcards
What does ageing impact?
- How well the body copes with new and ongoing insults
- How we treat and manage patients
- Ongoing care- becomes more challenging
Why is it important to consider the impact of ageing?
Over 50% of older people have at least 2 chronic conditions
WIll be treating older people in all branches of medicine (except paeds)
How does the skin change as we age?
- Elastic tissue becomes less effective
- Skin becomes less tight
- Becomes thinner and more susceptible to damage ergo more fragile
What problems happen as the skin ages?
Bruises easily
Difficult to get IV access
Skin tears
Ulcerates easily
How does reduced elasticity effect the lungs?
- Decreased compliance
- Decreased passive exhalation
- Also important in holding open terminal airways and alveoli
- Results in weakened/ineffective cough, stasis of mucus leading to infection
What values decrease which are used to measure lung health in ageing patients?
Total lung capacity
Forced vital capacity
Forced expiratory volume
What external factors can cause premature degeneration of the elastic tissue in the lungs?
- Work exposure- asbestos
- Smoke exposure
- Repeated infections
- Chemical/toxin exposure- fibrosis causing, e.g. amiodarone
What does reduced lung function put you at a greater risk of?
More likely to
-Be acutely unwell
-Need hospitalisation
-Need oxygen/ IV antibiotics
What post-operative respiratory complication are more likely in elderly patients?
Atelectasis
Pneumonia
Pulmonary embolism
What type of drugs are more likely to cause respiratory problems?
Sedating drugs
How is the CVS affected by ageing?
Blood vessels become more stiff as we age, particularly arteries (Ca2+ deposition + elastic tissue degeneration)
Elastic recoil is reduced, less expansile arteries
-Increased resistance to blood flow
-Hypertension
-Increased cardiovascular work
-Increased riskof LVH
-Decreased left ventricular volume
-Heart failure, left initially then right
What are the risks of uncontrolled hypertension?
Stroke
MI
CKD
HF
AF leading to stroke
Vascular disease e.g. AAA
Vascular dementia
Vision
How does hypertension lead to atrial fibrillation?
- Increased stretch of the atria
- Atrial stretch causes small areas of damage
- New foci of electrical activity
- APs generated by new foci
What happens to the renal system as we age?
GFR decreases, roughly decreases by 1ml/min/m2 from 30-40
What causes GFR to decrease as we age?
Structural changes
Atheromatous vascular disease
Reduced CO
Why is decreased GFR such an issue?
Many medications are excreted renally, if these remain high in the blood could cause toxicity
What two major disease affect the renal system?
Diabetes
-Leads to diabetic nephropathy, damage to microvascular structures due to hyperglycaemia
Hypertension
-Medication reduces BP
-Some medications are nephrotoxic- ACEi and NSAIDS
-Need to be careful and review medications when patients are unwell
What are the effects of ageing on the musculoskeletal system?
Bone
-Bone density decrease, gradual
-Declines more quickly in women after menopause
Muscle
-Muscle mass decreases, multifactoral
Bone marrow
-Less cellular and more fatty
-Decreased cellular production
What are the consequences of decreased bone density and muscle mass?
- Increased risk of fracture
- Increased fall risk
- Increased trauma risk
- Osteoporosis
How is the GI system affected by ageing?
Live function gradually reduces over time- decreased blood flow to liver and decreasde mass of functional liver cells
Slower transit through intestines- increased constipation
Decreased absorption- reduction in absorption of nutrients and medication
Why is malnutrition important?
Common issue in elderly people
Good nutrition is essential for recovery from illness
Malnourishment leads to longer hospital stays
Wound healing is slower
Screening on admission of ALL patients to assess risk
How is wound healing particularly affected by malnutrition?
After surgery more likely to have wound breakdown or delayed healing
Increased risk of pressure ulcers
Pressure ulcers difficult to heal without good nutrition
How is the brain affected by ageing?
-Atrophy, particularly areas related to learning and complex mental activities
-Senescence of some cells
-Reduced communication between neurones
-Reduced blood flow
-Neuronal density reduced by almost 1/3 by age of 80
What are the 4 classic features of cerebral atrophy?
Ventricular enlargement
Cortical thinning
Volume loss
Sulcal widening
What are the different types of dementia?
Alzheimer’s
Vascular
Fronto-temporal
Lewy body
How is prescribing affected in elderly patients?
- Have to balance benefit to side effects
- More likely to be on medications already, risk of interactions
- Reduced renal and liver excretion of drugs, may need: dose reduction, alternatives, close monitoring, starting at lower dose
- Cannot focus on just one body system
If there is a drug interaction between prescribed medications what do you do?
If there is no alternative you must consider which medication is more important
What needs to be considered in care of an elderly person?
What does the patient want?
How can we achieve it?
What are the persons beliefs?
Treating with dignity
Working in accordance with best interests
What social needs do they have?
Is a hospital the best place for them?
Why is loneliness important?
People may not want to be discharged as they feel lonely and like having company
How do we ensure that patients recieve the care that they want?
Planning for the future
-Advance care planning, e.g. DNRS
-Emergency healthcare plans, reduces hospital admissions unless no other options
Respect forms
-What is important to the patient, treatment vs symptom control
-Resuscitation
Involve family/carers/freinds
-They know the person better than you
